R-Endo 镍钛系统在根管再治疗中的应用

doi:10.3877/cma.j.issn.1674-1366.2014.04.004

目的

评价R-Endo 镍钛机用器械在离体牙根管再治疗中的应用性能。

方法

收集根尖孔发育完成的单根管恒牙，根据根管弯曲度分层随机分组。使用牙胶或RealSeal 树脂充填，而后分别使用Gates-Glidden 钻+K 锉、HERO 642 镍钛机动和R-Endo 镍钛机动再治疗。记录再治疗时间及从根尖孔推出的碎屑重量，并拍摄术后X 线片，AutoCAD 2008 软件分析残余充填材料与根管壁的面积比。

结果

R-Endo 镍钛系统再治疗时间较长（P=0.003）；推出根尖孔碎屑量较Gates-Glidden 钻+K 锉少（P=0.001），与HERO 642 镍钛系统相比差异无统计学意义（P=0.239）；根管内残余充填材料与根管壁的面积比低于其他两组，但差异无统计学意义（P=0.157）。 RealSeal 充填组再治疗时间（P=0.001）和推出根尖孔碎屑（P=0.028）均低于牙胶充填组，两者间差异均具有统计学意义（P ＜0.05）。

结论

R-Endo 机动镍钛系统是根管再治疗的有效方法，其根管清理性能优于手动器械，对根尖周组织激惹度较传统手动器械小，但器械的安全性有待提高。

关键词: 根管再治疗, 镍钛, R-Endo 机动器械

Objective

To evaluate the efficacy of R-Endo Nickel-Titanium rotary instruments in endodontic retreatment in vitro.

Methods

Extracted caries-free mature single-rooted permanent teeth were collected and divided into 6 groups according to the canal curvature. The teeth were obturated by gutta-percha and RealSeal resin obturation system， and retreated by Gates-Glidden drills. K files， HERO 642 Nickel-Titanium rotary instruments and R-Endo Nickel-Titanium rotary instruments， respectively. The total time of retreatment was recorded， extruded debris was collected and weighed. Moreover， the image of residual filling materials was outlined and measured by AutoCAD 2008 software.

Results

R-Endo system took more operating time than the other 2 methods （P=0.003）. And R-Endo system produced significantly less debris extrusion than by Gates-Glidden drill and K file （P=0.001）， but there was no significant difference between R-Endo an HERO 642 （P=0.239）. Moreover， the mean ratios of remaining fillings versus the area of groups retreated by R-Endo system was lower than other 2 groups， but of no statistically difference （P=0.157）. Besides， canals obturated by RealSeal resin obturation system took less operating time （P=0.001） and produced less debris extrusion （P=0.028） than by gutta-percha （P ＜0.05）.

Conclusions

R-Endo Nickel-Titanium rotary system is effective in endodontic retreatment. In comparison with hand instruments， it is more effective in canal wall cleanliness and less irritative to the periapical tissue. But the necessity for improvement on its safety should be recognized.

Key words: Endodontic retreatment, Nickel-Titanium, R-Endo rotary instruments

图1 离体牙根管弯曲度的测量注：图1A 为1 号标本颊舌向观根管弯曲度为11°；图1B 为1 号标本近远中向观根管弯曲度为2°

图2 根管再治疗碎屑收集装置

图3 根管清洁度检测注：图3A 为33 号标本颊舌向观；图3B 为33 号标本近远中向观

表1 根管再治疗器械变形统计（例）

器械	型号	变形数量
K锉	25^#	2
	30^#	1
HERO 642镍钛机动锉	25^#/04	2
	25^#/06	2
	30^#/04	1
	30^#/06	1
R-Endo镍钛机动锉	R1	2
	R2	3
	R3	2

表1 根管再治疗器械变形统计（例）

器械	型号	变形数量
K锉	25^#	2
	30^#	1
HERO 642镍钛机动锉	25^#/04	2
	25^#/06	2
	30^#/04	1
	30^#/06	1
R-Endo镍钛机动锉	R1	2
	R2	3
	R3	2

表2 根管再治疗评估（±s）

组别	离体牙数	再处理时间（min）	碎屑重量（×10^-3g）	充填材料面积比（%）
组别	离体牙数	再处理时间（min）	碎屑重量（×10^-3g）	颊舌向	近远中向
1	15	3.60±0.83	1.9520±0.6843	2.468±4.268	2.368±3.335
2	15	4.50±0.76	0.7547±0.5241	3.227±4.398	2.812±4.421
3	13	5.06±0.66	1.0514±0.6143	1.209±2.490	2.335±4.046
4	15	3.56±0.95	1.3933±0.6093	3.156±3.256	4.830±4.644
5	15	2.84±0.68	0.5387±0.3411	6.480±9.140	4.889±5.622
6	15	4.10±0.59	0.7647±0.3914	2.304±3.206	2.206±2.990
合计	88	3.92±1.02	1.0086±0.7368	3.260±5.191	3.277±4.282

表2 根管再治疗评估（±s）

组别	离体牙数	再处理时间（min）	碎屑重量（×10^-3g）	充填材料面积比（%）
组别	离体牙数	再处理时间（min）	碎屑重量（×10^-3g）	颊舌向	近远中向
1	15	3.60±0.83	1.9520±0.6843	2.468±4.268	2.368±3.335
2	15	4.50±0.76	0.7547±0.5241	3.227±4.398	2.812±4.421
3	13	5.06±0.66	1.0514±0.6143	1.209±2.490	2.335±4.046
4	15	3.56±0.95	1.3933±0.6093	3.156±3.256	4.830±4.644
5	15	2.84±0.68	0.5387±0.3411	6.480±9.140	4.889±5.622
6	15	4.10±0.59	0.7647±0.3914	2.304±3.206	2.206±2.990
合计	88	3.92±1.02	1.0086±0.7368	3.260±5.191	3.277±4.282

表3 根管内不同部位残余充填材料面积比（%，±s）

拍摄角度	颊舌向	近远中向
Gates-Glidde 钻+K 锉组	2.602±3.714	0.277±4.067
HERO 642 镍钛机动锉组	5.085±7.386	4.025±5.136
R-Endo 镍钛机动锉组	1.887±2.944	2.351±3.464

表3 根管内不同部位残余充填材料面积比（%，±s）

拍摄角度	颊舌向	近远中向
Gates-Glidde 钻+K 锉组	2.602±3.714	0.277±4.067
HERO 642 镍钛机动锉组	5.085±7.386	4.025±5.136
R-Endo 镍钛机动锉组	1.887±2.944	2.351±3.464

图4 变形和折断的根管再处理器械

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The efficacy of R-Endo Nickel-Titanium rotary instruments in endodontic retreatment

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The efficacy of R-Endo Nickel-Titanium rotary instruments in endodontic retreatment